Pain and the Family Caregiver
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Guided by comprehensive assessment of clinical knowledge gaps and needs, this educational activity is intended to highlight the essential role of pain management in interdisciplinary palliative care.
Pain specialists (anesthesiologists and neurologists), general practitioners, palliative care specialists, nurse practitioners, pharmacists, allied health professionals, fellows, residents, and medical students.
Statement of Need
As a critical aspect of palliative care, managing pain at the end of life begins with a thorough assessment of biologic, psychological, and social aspects of the pain experience.1 Multimodal, patient-focused treatment strategies can then be implemented to alleviate suffering and provide comfort for patients and their families.2,3 Healthcare providers must be familiar with the full analgesic armamentarium, including opioid and nonopioid medications, psychosocial approaches, and interventional options.4-7 It is essential to address common side effects proactively, consider drug rotation if patient responses are inadequate, and combine therapies that maximize pain relief and minimize adverse events. Indeed, an interdisciplinary approach is often needed to address physical and spiritual aspects of end-of-life pain concomitantly.4,8,9 Each component of pain assessment and treatment must also be filtered through the lens of the individual patient, taking into account cultural and experiential influences on symptoms and therapeutic preferences. Increased utilization of palliative care resources, improved adherence to pain management clinical guidelines, and evidence-based education for patients and caregivers are required to care appropriately for patients with advanced illness, achieve quality improvement, and lay the foundation for palliative care research.
Despite the prevalence of pain among patients in palliative care, appropriate analgesic approaches are too often overlooked.1,10 Patients with advanced illness describe unrelieved pain as their most troubling disease manifestation,5 yet some clinicians perceive end-of-life symptom control as an alternative to disease-focused treatment. Barriers to effective pain management in palliative care are multifactorial, including misconceptions that effective analgesic strategies may hasten death, an unwillingness or inability among some healthcare providers to prognosticate approaching death, and poor remuneration compared with acute care and procedural medicine. Comprehensive pain treatment in palliative care should be based on an interdisciplinary approach in which active management of disease processes is combined with essential psychosocial and spiritual support, and at times concurrent curative therapies.2,3,7,9
- Hanlon JT, et al. Pain and its treatment in older nursing home hospice/palliative care residents. J Am Med Dir Assoc. 2010;11:579-583.
- Desa V, et al. An interdisciplinary and collaborative initiative in palliative care research. J Pain Res. 2008;2:1-3.
- Irwin SA, Ferris FD. The opportunity for psychiatry in palliative care. Can J Psychiatry. 2008;53:713-724.
- Ferris FD, et al. Palliative cancer care a decade later: accomplishments, the need, next steps—from the American Society of Clinical Oncology. J Clin Oncol. 2009;27:3052-3058.
- Gavrin JR, McMenamin EM. Pain management in palliative care oncology patients. Curr Pain Headache Rep. 2008;12:257-261.
- Joshi M, Chambers WA. Pain relief in palliative care: a focus on interventional pain management. Expert Rev Neurother. 2010;10:747-756.
- Dy SM. Evidence-based approaches to pain in advanced cancer. Cancer J. 2010;16:500-506.
- Selman L, et al. The measurement of spirituality in palliative care and the content of tools validated cross-culturally: A systematic review. J Pain Symptom Manage. 2011 Feb 8 [Epub ahead of print].
- Bradley SE, et al. Patients' psychosocial experiences of attending Specialist Palliative Day Care: A systematic review. Palliat Med. 2011 Jan 12 [Epub ahead of print].
- Gardiner C, et al. Barriers to providing palliative care for older people in acute hospitals. Age Ageing. 2011;40:233-238.
At the conclusion of this symposium, you will be able to:
- Recognize the effect of the patient's and family's psychological status on the pain experience in the setting of advanced illness
- Assess the impact of pain on the family caregivers of palliative care patients
- Evaluate the role spirituality and spiritual forms of coping may play in the experience of illness and pain
- Recognize the importance of cultural differences when developing an approach to pain management for patients and their families
- Describe the importance of quality improvement programs and ongoing research in palliative care
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of Beth Israel Medical Center, St. Luke’s & Roosevelt Hospitals, and Asante Communications, LLC. Beth Israel Medical Center and St. Luke’s & Roosevelt Hospitals are accredited by the ACCME to provide continuing medical education for physicians.
Myra Glajchen, DSW has reported that they do not have any financial relationships to disclose
Credit Designation designates this internet point-of-care activity for a maximum of 1.0 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Method of Participation
There are no fees for participating in and receiving credit for this activity. Prior to viewing the webcasts, each participant must read the learning objectives and acknowledge receipt of the CME information. Additionally, each participant must also complete a prequestionnaire before beginning the activity. Upon completion of this prequestionnaire, the activity will commence. Once the final webcast is viewed, credit may be obtained by completing the posttest, program evaluation, and the attestation statement. Credit is available through March 10, 2012.
As herein stated, the term "Continuum Affiliates" means Beth Israel Medical Center, St. Luke's-Roosevelt Hospital Center, Long Island College Hospital, and the New York Eye & Ear Infirmary. Continuum Health Partners, Inc. is the parent company of each of the Continuum Affiliates.
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